Presentation on theme: "MENTAL HEALTH & Substance Abuse Concurrent Disorders SWRK 2083"— Presentation transcript:
1MENTAL HEALTH & Substance Abuse Concurrent Disorders SWRK 2083 Keith Cameron, M.A., M.B.A.
2Agenda Week 1 Introduction Course Outline & Administrative Issues Introduction to Concurrent DisordersDefinition of Key TermClinical ComplexityClass practical exercises
3IntroductionKeith Cameron, M.A., M.B.A.Contact InformationNo contact at the CollegeWeb site:It is your responsibility to access the web-site for power point presentationsThey will be posted by the end of the day on the Tuesday prior to classI will not be bringing copies to classOther information may be posted that is FYI only but may be beneficial in assignments or the test
4Course OutlineEVALUATION SYSTEM:Week 3 – Multiple Choice Quiz (20%)Open book and work in pairsWeek 4 – Small Group Work – 3 maximum (30%)Week 7 – Final Multiple Choice (40%)Attendance (10%)Those that have been granted job status will be prorated out of 90Religious holidays. It is the student’s responsibility to discuss this issue with your professor at least one week before the holiday.Students registered with Disability Services are required to supply confirming documentation to the professor and inform him/her of any plans to write tests in privateIt is your responsibility to read and understand the course outline. Ask if you are not sure
5Course Outline – Cont’d ASSIGNMENT POLICY: PLS. READ CAREFULLY!Group work is submitted at the end of class.If 1 assignment is missedYou must contact the professor on the day of the assignment at the latest ( no documentation is required)byIf you have contacted the professor, only then will be eligible for a make up after the final test on week 7If you miss a second assignment:You must contact the professor on the day of the assignment and must provide documentation within one week to access any accommodationGroups will consist of 3 membersEach member is to participate in written responseMembers are expected to participate equally and remain until the work is completed.Groups who sign in a missing group participant will be liable for sanctions as a whole ( i.e. 0 on that assignment)To view George Brown College policies go to
6General Comments Please ask questions If you don’t know others also don’t knowIt is your right to have explanations and clarificationsVery often there are not right and wrong answersBecause I say it doesn’t mean it is rightI would request that any backbench talking be done outside the classThis is disturbing to me and the rest of the classI will not talk above other peopleTurn cell phones offIf there is an emergency call awaiting let me knowKeep assignments including scantrons in case of a discrepancy in marks. No marks will changed without this back-up support
7A Few Pointers Readings Reading package available at College Note that when you first open “Health Canada” document it is in Roman numerals – keep scrolling down until you get to the page numbersNote page number on the document will not correspond to the scroll down pages on the left
8Mental Illness..................S. Abuse: How we define them Context of BehaviourSocial DeviancePersistence of maladaptive behavioursSubjective distressSeverityImpact on functioningToleranceWithdrawal symptomsNeed more, same effectPersistent drive for substance, or failure to cut backTime spent getting itReduce social/work activitiesUse despite health/social problems
9Some Themes for the Course ComplexityNumerous MH disorders combined with different disordersAge/demographicsAssessing Concurrent Disorders (CD)What came first?What do we treat?TreatmentWhat do we treat firstCauses of CDWhat went wrong in childhood?FocusMood + AlcoholAnxiety + AlcoholPsychosis & Cannabis
10Definition What is your understanding of the term Concurrent Disorders What it is not!
11What do We Mean by Concurrent Disorders? At least one mental health disorder as defined by DSM-IVPlus substance abuse or dependence as defined by DSM-IVMulti combinations and variations, including multi-morbidityAcross drugsAcross mental disordersDemographics/cultural groups
12Abuse vs. DependenceSubstance abuse is a pattern of drug, alcohol or other substance use that creates many adverse results from its continual use. The characteristics of abuse are a failure to carry out obligations at home or work, continual use under circumstances that present a hazard (such as driving a car), and legal problems such as arrests. Use of the drug is persistent despite personal problems caused by the effects of the substance on self or others.Substance dependence has been defined medically as a group of behavioural and physiological symptoms that indicate the continual, compulsive use of a substance in self-administered doses despite the problems related to the use of this substance. Sometimes increased amounts are needed to achieve the desired effect or level of intoxication. Consequently the patient's tolerance for the drug increases. Withdrawal is a physiological and psychological change that occurs when the body's concentration of the substance declines in a person who has been a heavy user.
13Definition in Canada (Similar in the USA) “A combination of mental/emotional/psychiatric problems with the abuse of alcohol and/or other psychoactive drugs…any combination of mental health and substance use disorders, as defined in DSM IV.” (Cooper & Calderwood in readings)In definition, the DSM–IV is used as the tool for diagnosis (Axis 1 & 2)
16Not Dual DisordersPeople with MH + Substance abuse may have more than 2 disordersDual DisordersIn Canada, refers to Developmental Delay & a Mental Health issueConcurrent DisordersIn Canada, captures complexity of substance abuse with mh
17Prevalence Data From Journal of American Medical Association Large overlap: between substance use and mental health disordersMost clients who actually seek treatment have a concurrent disorder
18Some Stats 50% of seriously mentally ill affected by substance abuse 90% of mentally ill smoke heavily77% of those treated for alcohol-related disorders have experienced at least one other psychiatric disorder in their lifetimes.
19Some Specifics Schizophrenia Bipolar Disorder 47% also have a substance abuse disorder, which is 4x the risk of the general populationBipolar Disorder61% also had a substance abuse disorder which is 5x the risk of the general population
20Specific RisksCompared to general population the lifetime risk for developing alcohol dependence is:21 times higher for Antisocial Personality6 timers higher for those with Mania4x higher for those with schizophrenia2x higher for those with panic disorder, major depression, & OCD
21Most Common Combinations SpecificallyMood Disorder plus AlcoholAnxiety Disorder plus Alcohol
22Five Most Common Groupings (Health Canada) Substance Use + Mood & Anxiety DisordersSubstance Use + Severe & Persistent MHSubstance Use & Personality DisordersSubstance Use + Eating DisordersOther Substance Use & MH
23Key to PractitionersOnly a minority of substance abusers and those with mental health problems reach out for help….but…“…those in the general population with concurrent disorders present the highest probability of seeking treatment.” Kessler
24Key----US Study: Respondents with alcohol use disorders were five times as likely to see help when they also had a mental health problem.“Those who seek help are the most severe cases in the general population…and are more often readmitted to treatment.”
25Article: “Multiple Identities, Multiple Barriers”: U. Chandraseskera “Intersectionality:”‘The experience of living with multiple stigmatized identities, facing multiple layers of discrimination.’
26Complexity = Multiple Identities Each with its own unique issues…M IllnessClassS AbuseNew CanadianPeople of ColorLGBTQGender
27Consequences of Having a Concurrent Disorder Statistically, clients have a greater propensity for violence, medication non-compliance, and failure to respond to treatment…compared with clients with substance abuse only or mental illness only“These consumers are in and out of hospitals and treatment programs without lasting success.” (NAMI)Treatment takes longer to work
28Consequences --- ‘Downward Drift’: Mental illness lands clients in poor housing, in neighborhoods where drug use prevails…inability to form social relationships, isolation can lead to joining the drug sub-culture
29Consequences --- Leads to homelessness or jail: Half of the mentally ill homeless have substance abuse problems31% a concurrent disorder16% of prison inmates have concurrent disordersLeads to overall poorer physical health and greater chance of relapse“these consumers are in and out of hospital and treatment programs without lasting success.” (Nami)
30Services lack integration “Often only one of the disorders is identified. If both are recognized, the individual may bounce back and forth between services, or be refused service by one of them….Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.” (NAMI)
31Why CD Clients Quit Treatment Enter treatment in crisis or chronic stateTherapeutic alliance tougher to establishTreatment streams not integrated (one disorder recognized)Clients need longer-term treatment that many agencies do not offerPattern of failed relationships, abuse: attachment issues
32Double StigmaIs it better to be drug user or a mental health consumer?Mental HealthBecoming less stigmatizedMore educationBetter outcomesAddictionsStill seen as a moral failureJudged more harshly
33Internalized StigmaAddiction: harsh judgment by our culture creates more durable internal stigmaBeliefs: I’m a loser, I’m a bad person, I don’t deserve help, I don’t deserve love
341+1 = more than 2 Substances can make MH meds less effective Substances can lead to clients forgetting to take MH medsRelapse with one triggers symptoms of other problemSubstances make MH problems worseSubstances mimic or hide MH problemsSubstances used to relieve MH symptoms(Self-medication)
35Consequences for Treatment Overall, poor outcomes: chronic coursePoor physical healthHigh relapse rates‘Recidivism’So: clients more likely to seek help, and also to quit help
36Treatment“Co-existing mental disorders increase the probability of abandoning treatment prematurely.”WHY?
38Bio-Psycho Social Model Review A framework that incorporates theNATURE vs. NURTURE controversyExamines the positive strengths of the consumerRecognizes the biological predisposition of mental illnesses & addictionsRecognizes the negative and positive elements in the environmentOrganizes information in a way that can be communicated and include the consumer in decision makingRecognizes the importance of the consumer in the treatment process
39Group AssignmentAs a group list your experience the last time you drank a lot of alcohol?Biological/Psychological/Social-Spiritual + BehaviouralBiologicalPsychologicalSocialBehavioural
40List Features of Depression Consider such things as thinking, judgment, inherited vulnerability, depressed CNS, memory, social functioning, moodBiologicalPsychologicalSocialBehavioural
41Alcohol Abuse vs. Depression How do we distinguish depression and alcohol abuse?Does alcohol abuse mask depression?Which came first?Does one cause the other?Are they both hereditary or environmental?Common pathwayAssessment is challenging
42Add Other Factors That May Affect Assessment and Treatment